Code Red

Six years ago, the release of “Code Red,” a report on the problem of the uninsured in Texas, written by a task force sponsored by the state’s 10 academic health centers (including the University of Texas Health Science Center), got quite a bit of attention.

By contrast, an update of the report released earlier this week got very little — despite the fact that some of the new recommendations are pretty interesting, and even provocative. The report can be found here.

Many of the recommendations centered on the Medicaid waiver granted to Texas in December, which promises to send billions more dollars to Texas hospitals in return for them working together to better treat the uninsured.

The report encourages state and local governments, along with local communities, to work together to draw down the most federal Medicaid funds available through the waiver. In Texas, that requires a local government agency or public hospital to put money into a pool to draw down the federal dollars.

That leads to perhaps the most provocative recommendation in the report: that the Legislature consider a 1 percent tax on all hospitals and freestanding surgery centers to draw down the most allowable federal funds.

The 1115 demonstration waiver granted to Texas has attracted national attention. Only California has gotten a similar waiver. Over the next few years, it will slowly move billions of dollars that already go to Texas hospitals — supposedly for taking care of the uninsured — into a separate pool of funds (along with a few billion extra to sweeten the deal) with strings attached.

Those strings involve making all the hospitals in a region work together on the needs specific to that region. In Bexar County, for example, improving behavioral health services has been identified as a great need here, and one likely to be included in our regional plan.

The task force calls for communities to put together strong regional plans, and suggests those plans include strengthening primary care so that every Texan, including the uninsured, has a “medical home” where treatment is coordinated.